Provider Demographics
NPI:1568672442
Name:BOSCH, KENNETH J (DMD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:J
Last Name:BOSCH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 LIAN DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-6891
Mailing Address - Country:US
Mailing Address - Phone:610-793-1453
Mailing Address - Fax:
Practice Address - Street 1:1050 BALTIMORE PIKE
Practice Address - Street 2:SUITE 4
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2853
Practice Address - Country:US
Practice Address - Phone:610-543-5996
Practice Address - Fax:610-543-5129
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027974L1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics